Professional Documents
Culture Documents
LEAVE NO ONE BEHIND. To uphold the promise of Agenda 2030 and the Sustainable
Development Goals (SDGs), Member States must recognize and address the fact that key
populations, including people who use drugs, gay men and other men who have sex with
men, bisexual people, transgender people, male, female and transgender sex workers, and
young women and adolescents, are the groups most at risk for HIV. It also means a
permanent commitment to collecting age- and sex-disaggregated data, including
information about groups that are often invisible to data collectors. The requires close
collaboration and regular consultation with community members to ensure that data is
safely collected, using human rights metrics, and that it captures the diversity of
communities affected by HIV.
II.
PROTECT AND UPHOLD HUMAN RIGHTS: All Member States must eliminate discriminatory
laws, policies and practices, adversely affecting people living with HIV, gay men and other
men who have sex with men, sex workers, people who use drugs, transgender people, and
women and girls, while ensuring human rights are upheld and protected, including the right
to health. Along with multilateral financial institutions, all member states must also support
action to address human rights abuses, including gender-based violence (including sexual
violence) and discrimination and stigma. To do this effectively, they must invest in human
rights interventions. The risk of inaction is a failure to achieve healthy lives (SDG 3).
III.
IV.
ENSURE TREATMENT ACCESS NOW: Access to treatment, care and support, particularly
among key populations (SDG 3) is a staple element of the response. Member States, with
the support of donors, international organizations and the UN, must ensure that all people
living with HIV needing and wanting treatment are able to receive it. In addition, Member
States must ensure that access to treatment in developing countries is consistent with the
World Trade Organization Declaration on TRIPS and Public Health (Doha Declaration).
REVIVE THE PREVENTION REVOLUTION: Prevention must remain central to all HIV
responses. Combination HIV programs include a full range of complementary, acceptable,
accessible, high-quality bio-medical (e.g., condoms, pre and post exposure prophylaxis
PrEP and PEP and voluntary medical male circumcision (VMMC),), behavioral, community,
social, and structural interventions. HIV-related programs should meaningfully involve
communities at all levels, be well managed with sufficient capacity, scaled up to reach at
least 90% of those in need, be well managed with sufficient capacity, scaled up to reach at
least 90% of those in need and be aligned with global guidance developed and supported by
the WHO and UNAIDS.
VI.
ACHIEVE GENDER EQUALITY: Gender inequality and violence heighten vulnerability to HIV.
Member States must commit to meaningfully addressing gender inequality (SDG 5) and
gender-based violence across all levels of the response. All Member States must ensure
greater and more effective linkages between sexual and reproductive health (SRH) and HIV
service. SRH services should be fully funded and include programs for caregivers of family
members living with HIV, the majority of whom are women and girls. SRH programs should
also address gender-based violence and be tailored to the needs of key populations,
including transgender women. Responses should be evidence-informed and be ready to
address emerging issues, such as cervical cancer, HPV, and gender-specific presentation of
tuberculosis and malaria.
VII.
VIII.
FULLY FINANCE A COMPREHENSIVE HIV REPONSE: We must ensure that resources match
need. 1 Member states, donors, the international community and the UN must reenergize
strained funding sources (SDG 17). The UNAIDS Fast Track goals have laid out an ambitious
target of ending the AIDS epidemic by 2030 but this plan will be little more than rhetoric
without creative thinking and bold action to scale up and sustain the investments required.
Stakeholders in the field of public health and thought leaders and partners in financing and
UNAIDS has calculated that US$ 31.3 billion are needed in 2020 to reach the UNAIDS 2020 fast track targets. At current levels,
this means a gap of US$ 9 billion globally.
X.
Slogans and simple answers will not end the AIDS epidemic. Efficiencies in health service delivery will
not get us there alone. Political leaders at the community, national, regional and global levels must
recommit to take real steps to end AIDS. This means using a human rights approach to:
a. Address punitive policies and practices that prevent people vulnerable to, at risk of and living
with HIV from receiving the health, legal and social services they need;
b. Eliminate laws that criminalize HIV transmission, exposure and non-disclosure, homosexuality,
gender non-conformity, sex work, and drug use; and
c. Challenge trade and aid policies that hamper HIV commodity production, purchasing and
distribution systems.
(20151026_PCB37_EXDreport_en), at p.6.
For more information, please see http://www.cdc.gov/tb/topic/tbhivcoinfection/default.htm; https://www.usaid.gov/news-information/factsheets/twin-epidemics-hiv-and-tb-co-infection; and http://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1002464.
3
I.
LEAVE NO ONE BEHIND. In the context of HIV, leaving no one behind requires that member
states recognize and address the fact that key populations, including people who use drugs,
gay men and other men who have sex with men, bisexual people, transgender people, male,
female and transgender sex workers, and young women and adolescents, are the groups
most at risk of HIV. The risk of inaction = no end in sight for the HIV epidemic.
It also means a permanent commitment to collecting age- and sex-disaggregated data, including
information about groups that are often invisible to data collectors. The requires close collaboration and
regular consultation with community members to ensure that data is safely collected, using human
rights and gender metrics, and that it captures the diversity of communities affected by HIV.
II.
PROTECT AND UPHOLD HUMAN RIGHTS: All member states must commit to a human
rights based approach to the HIV response that respects, protects, promotes and fulfils
sexual and reproductive health and rights and eliminates discriminatory laws, policies, and
practices. This requires specific attention to repealing laws, policies and practices that
increase HIV risk and those that discriminate against key populations and fail to protect
women and girls, because such laws, policies and practices render services inaccessible and
unaffordable. Along with multilateral financial institutions, all member states must also
support action to address human rights abuses, including gender-based violence, sexual
violence, discrimination, stigma and human rights violations in healthcare settings. These
actions are essential to achieving healthy lives (SDG 3).
Today, unaddressed HIV epidemics among these groups threaten to undermine gains made to date in
reaching global HIV targets unless countered with evidence-informed and human rights affirming
interventions at scale. Moreover, concentrated HIV epidemics in these groups continue in many
countries -- both high and low-incomeand in countries with generalized epidemics. Access to
treatment, to rights-based sexual and reproductive health programs and to legal services is often
undermined by punitive laws, counterproductive policies, human rights abuses, and violence fueling
stigma, discrimination and persistent disparities.
Women and girls carry a significant burden of HIV both as women living with HIV and as the primary
caretakers for family and community members living with HIV. In many Eastern and Southern Africa
countries, women and girls are contracting HIV two to five times more than men and boys of the same
age. 4 Action to address gender inequality everywhere in the world is a central element to effective HIV
responses (SDG 5). The risk of inaction is severe continued growth of HIV, especially among people
who face discrimination and inequality. Targeted attention to marginalized people and communities,
such as indigenous peoples, people with disabilities, migrants, prisoners/people deprived of their liberty,
and other who face criminalization because of their sexual orientation, gender identity or because they
are sex workers or people who use drugs is always essential to effective strategies, policies and
programs.
III.
ENSURE TREATMENT ACCESS NOW: Access to treatment, care and support, particularly
among key populations (SDG 3) is a staple element of the response. However, member
states still delay ensuring that all adults, adolescents and children needing and wanting
treatment are able to receive it. The risk of inaction is a rise in HIV among those
communities for whom treatment is inaccessible and continued preventable mortality and
morbidity.
Member states should commit to time-bound treatment (ARV) scale-up goals. The pace of increasing
access to ARVs will have a direct correlation with achieving reduced morbidity, reduce death, and fewer
new infections, including reaching more than 30 million people with life-saving ART by 2020 and
increasing the number of new people on ART by 20% on an annual basis. Access to treatment must align
with new WHO recommendations. Additionally, member states must ensure that access to treatment in
developing countries is consistent with the World Trade Organization Declaration on TRIPS and Public
Health (Doha Declaration)
To be successful, member states must commit to scaling-up of essential adherence support pillars, such
as provision of routine viral load, ART-friendly strategies including differentiated models of care and
flexible refill schedules, and adherence counseling, including ensuring health workers are adequately
trained, paid, and supported. In addition to ART scale-up, member states should commit to qualitative
as well as quantitative indicators that reflect scale-up HIV services, improve linkages, increase support
for adherence, and disaggregate data (by age, gender, and key population). Further, member states
must meet the 90-90-90 targets for children and ensure that children living with HIV are on treatment,
receiving holistic care and virally suppressed.
Furthermore, member states must expand efforts to combat tuberculosis, which is the leading cause of
death among people living with HIV, by improving tuberculosis screening, prevention, access to
diagnosis and treatment for all forms of tuberculosis including drug-resistant tuberculosis, and access to
antiretroviral therapy, through more integrated delivery of HIV and tuberculosis services in line with the
5
V.
REVIVE THE PREVENTION REVOLUTION: Prevention must remain as a central part of all
HIV responses with the strong participation of communities. Member states must be clear
that they see prevention as a priority, along with treatment, care and support services, and
act upon this recognition. The risk of inaction is continued high numbers of new infections,
and a continued separation of treatment and prevention, further frustrating efforts
toward a comprehensive response, and making treatment unaffordable.
ACHIEVE FOR GENDER EQUALITY: Robust evidence shows the relationship between gender
inequality and HIV. Member States must commit meaningfully to address gender inequality
(SDG 5) and gender-based violence across all levels of the response. The risk of inaction is
the continued disproportionate burden of HIV on women and girls, especially women and
girls living with HIV, and as members of key populations with distinct health needs,
including during and after pregnancy.
All member states must ensure greater and more effective linkages and increased support for work that
connects SRH and HIV programming as well as GBV and HIV programming, as well as robust support for
caregivers caring for family members living with HIV, the majority of whom are women and girls.
Responses must also respect and promote sexual reproductive health and rights, involve research and
evidence-informed programming on emerging issues such as cervical cancer, HPV, and gender-specific
presentation of tuberculosis and malaria. Maternal mortality disproportionately impacts women living
with HIV. Although improvements in health facilities and medical treatments have cut maternal
mortality rates by almost half in the past twenty years, maternal deaths caused by HIV have not seen
6
All countries must ensure access to prevention, treatment, care and support programing for the full
range of people living with and affected by HIV, from the very young to the very old. Each member state
must reorganize its national response to reflect the changing face of HIV and recalibrate their response
to prevention, treatment, care and support as a lifecycle approach. If not, HIV will continue to rise in
especially vulnerable to hard-to-reach communities, such as young women and adolescent girls,
migrants, and prisoners/people deprived of their liberty, among others.
Specifically, member states must recognize and increase the participation of young people and children
living with HIV in decision-making processes. Young people must be directly involved in designing,
implementing, providing, and monitoring services intended to meet their needs. With respect to people
who are aging, greater integration within health systems and services to address multi-morbidity and
the link between HIV and non-communicable diseases are needed. Regarding young children and
adolescents, the response must afford substantially more attention to pediatric and adolescent testing
and treatment, including treatment adherence, which can only be achieved by a comprehensive social
protection, care, support and child protection.
In addition, middle income and upper middle income countries should have in place costed transition
plans to ensure that treatment, prevention, care and support programs are not compromised as donors
such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, and many donor governments
withdraw. This must include enabling legal and policy environments to allow for contracting between
governments and civil society (social contracting) and commitments to continue services for key
populations previously supported by external donors. Donor governments and multilateral organizations
should continue funding programs and services that national HIV responses are unlikely to absorb, such
as monitoring and advocacy to ensure responsible transition planning.
Member states should also scale up interventions to address the social drivers of HIV, poverty and
inequality through HIV sensitive programs that ensure housing, educational and economic opportunity
and other supports that build resilience.
7
World Health Organization, Trends in Maternal Mortality: 1990 to 2013 Estimates by WHO, UNICEF, UNFPA, The World Bank and the United
Nations Population Division (2014), available at: http://apps.who.int/iris/bitstream/10665/112682/2/9789241507226_eng.pdf?ua=1 (45%
decrease in maternal morality from 1990 to 2013). Coceka Mnyani, et al., A 15-year review of maternal deaths in a background of changing HIV
management guidelines. 21st Conference on Retroviruses and Opportunistic Infections, Boston, abstract 67, 2014 (there has been no change in
the proportion of maternal deaths caused by HIV since 2007).
8
WHO, UNICEF. Accountability for maternal, newborn and child survival: The 2013 Update. Geneva: WHO; 2013.
FULLY FINANCE A COMPREHENSIVE HIV REPONSE: It is high time to ensure that resources
match need. 9 Member states, donors, the international community and the UN must
reenergize strained funding sources (SDG 17). The risk of inaction is an inexcusable global
failure to end the HIV epidemic, despite possessing the knowledge, technology and skills
to do so.
Countries of all income levels must receive the financial support they need to sustain the gains made
gains made thus far in combatting HIV and AIDS. Donors, the international community, the UN and
member states should allocate support based on evidence about who is most at risk and most affected,
for prevention, treatment and human rights programs. If not, the moment to end the HIV epidemic will
be delayed or lost. UNAIDS estimates that about a quarter of a fully funded global response need to be
allocated to prevention and half to treatment, if global targets are to be achieved.
The UNAIDS Fast Track goals lay out the ambitious target of ending the AIDS epidemic by 2030 but this
plan will be little more than rhetoric without creative thinking and bold action to scale up and sustain
the investments required. We need collective action now - not only from stakeholders in the field of
public health, but with joint action from thought leaders and partners in financing and development.
Without an all-hands-on-deck effort, this moment for action will dissipate without the requisite scaledup action.
Such efforts must also support financing for research and innovation. Member states should direct
increased human and financial resources to new and emerging technologies, such as: multi-purpose
technologies (MPTs) that enable women to simultaneously prevent pregnancy and sexually transmitted
infections, including HIV; second and third-line ARVs; and rights-protective distribution of PrEP. Greater
impetus to innovation also comes from implementation research, which helps to ensure that we gather
lessons about what works and what does not, and participatory research and data analysis to help us
better understand and address the social, structural, and political drivers of HIV.
IX.
All member states and multilateral funding institutions must place particular attention to the resource
gap in funding community action and activism. Action must include funding community-driven
responses, including involvement of faith-based organizations, with a caveat. While anchoring services
within the community is essential, governments must not offload their responsibility onto communities
without ensuring adequate human and financial resources.
Member states, donors, the international community and the UN must increase support to community
organizations, in order to improve service provision, advocacy, engagement, and monitoring of health
9
UNAIDS has calculated that US$ 31.3 billion are needed in 2020 to reach the UNAIDS 2020 fast track targets. At current levels, this means a
gap of US$ 9 billion globally.
10
For data on communities in the HIV response, see UNAIDS
www.unaids.org/sites/default/files/media_asset/UNAIDS_JC2725_CommunitiesDeliver_en.pdf
All member states must commit to supporting robust accountability mechanisms to ensure that they
translate commitments made in this 2016 AIDS Declaration are translated into effective AIDS responses.
They must also commit to periodic and inclusive reviews and reporting of progress towards meeting the
targets set, with the full and meaningful involvement of civil society, in particular people living with HIV
and key populations.
Accountability depends on full and meaningful participation. Yet, people living with HIV, key
populations, civil society and human rights defenders face increased restrictions on their rights to
engage in the public lives of their communities and countries. Without such engagement of these
groups, full accountability will not be possible. While the search for accountability is at the heart of
what national, regional and international human rights systems do, it should preoccupy governments,
the UN, and civil society. Accountability is a pillar upon which social justice and sustainable
development are built. While accountability is a core principle of human rights-based responses,
accountability principles and mechanisms can help to improve policymaking by identifying systemic
problems in order to make service delivery systems more effective and responsive.
10